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Marjoriitta Jarvelin - One of the best experts on this subject based on the ideXlab platform.
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Antenatal Corticosteroid therapy act and size at birth a population based analysis using the finnish medical birth register
PLOS Medicine, 2019Co-Authors: Mika Gissler, Alina Rodriguez, Yingbo Wang, Anohki Ali Khan, Rufus Cartwright, Marjoriitta JarvelinAbstract:Antenatal Corticosteroid therapy (ACT) is used clinically to prepare the fetal lung for impending preterm birth, but animal and human studies link Corticosteroids to smaller birth size. Whether ACT is associated with birth size is debated; therefore, we assessed differences in birth size in treated versus untreated pregnancies. Methods and findings This observational register-based study used data from the Finnish Medical Birth Register (FMBR) covering all births in Finland (January 1, 2006–December 31, 2010). We used unadjusted and adjusted regression analyses as well as propensity score matching (PSM) to analyze whether birth size differed by ACT exposure. PSM provides a stringent comparison, as subsamples were created matched on baseline and medical characteristics between treated and untreated women. All analyses were stratified by timing of birth. The primary study outcome was birth size: birth weight (BWT), birth length (BL), ponderal index (PI), and head circumference (HC) measured immediately after birth and recorded in the FMBR. Additional analyses explored indicators of neonatal health in relation to ACT exposure and birth size. A total of 278,508 live-born singleton births with ≥24 gestational completed weeks were registered in the FMBR during the 5-year study period. Over 4% of infants were born preterm, and 4,887 women were treated with ACT (1.75%). More than 44% of the exposed infants (n = 2,173) were born at term. First, results of unadjusted regression analyses using the entire sample showed the greatest reductions in BWT as compared to the other analytic methods: very preterm −61.26 g (±SE 24.12, P < 0.01), preterm −232.90 g (±SE 17.24, P < .001), near term −171.50 g (±SE 17.52, P < .001), and at term −101.95 g (±SE 10.89, P < .001). Second, using the entire sample, regression analyses adjusted for baseline and medical conditions showed significant differences in BWT between exposed and unexposed infants: very preterm −61.54 g (±SE 28.62, P < .03), preterm −222.78 g (±SE 19.64, P < .001), near term −159.25 g (±SE 19.14, P < .001), and at term −91.62 g (±SE 11.86, P < .03). Third, using the stringent PSM analyses based on matched subsamples, infants exposed to ACT weighed less at birth: −220.18 g (±SE 21.43, P < .001), −140.68 g (±SE 23.09, P < .001), and −89.38 g (±SE 14.16, P < .001), born preterm, near term, and at term, respectively. Similarly, significant reductions in BL and HC were also observed using the three analytic methods. There were no differences among postterm infants regardless of analytic method. Likewise, we observed no differences with respect to PI. Additional analyses showed that exposed and unexposed infants had generally similar Apgar scores at birth, yet the ACT-treated infants received greater medical care during the first 7 days of life and beyond. Our study is mainly limited by lack of data in FMBR specifying the interval between treatment and birth as well as other potential confounders that could not be tested. Conclusions In this study, ACT was consistently associated with reduction in birth size for infants born preterm, near term, or at term. Further investigation is warranted alongside reevaluation of guidelines. Efforts need to be made to correctly identify and target patients who will deliver preterm. Reduced growth should be considered when deliberating early care decisions.
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Pregnancies, ACT treatment, and timing of births.
2019Co-Authors: Alina Rodriguez, Mika Gissler, Yingbo Wang, Anohki Ali Khan, Rufus Cartwright, Marjoriitta JarvelinAbstract:ACT, Antenatal Corticosteroid therapy.
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exposure to Antenatal Corticosteroid therapy is associated with reduced size at birth evidence from finnish medical birth register of 278 508 births
Psychoneuroendocrinology, 2015Co-Authors: Mika Gissler, Alina Rodriguez, Yingbo Wang, Anohki Ali Khan, Rufus Cartwright, Marjoriitta JarvelinAbstract:Exposure to Antenatal Corticosteroid therapy is associated with reduced size at birth : Evidence from Finnish Medical Birth Register of 278,508 births
Alina Rodriguez - One of the best experts on this subject based on the ideXlab platform.
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Antenatal Corticosteroid therapy act and size at birth a population based analysis using the finnish medical birth register
PLOS Medicine, 2019Co-Authors: Mika Gissler, Alina Rodriguez, Yingbo Wang, Anohki Ali Khan, Rufus Cartwright, Marjoriitta JarvelinAbstract:Antenatal Corticosteroid therapy (ACT) is used clinically to prepare the fetal lung for impending preterm birth, but animal and human studies link Corticosteroids to smaller birth size. Whether ACT is associated with birth size is debated; therefore, we assessed differences in birth size in treated versus untreated pregnancies. Methods and findings This observational register-based study used data from the Finnish Medical Birth Register (FMBR) covering all births in Finland (January 1, 2006–December 31, 2010). We used unadjusted and adjusted regression analyses as well as propensity score matching (PSM) to analyze whether birth size differed by ACT exposure. PSM provides a stringent comparison, as subsamples were created matched on baseline and medical characteristics between treated and untreated women. All analyses were stratified by timing of birth. The primary study outcome was birth size: birth weight (BWT), birth length (BL), ponderal index (PI), and head circumference (HC) measured immediately after birth and recorded in the FMBR. Additional analyses explored indicators of neonatal health in relation to ACT exposure and birth size. A total of 278,508 live-born singleton births with ≥24 gestational completed weeks were registered in the FMBR during the 5-year study period. Over 4% of infants were born preterm, and 4,887 women were treated with ACT (1.75%). More than 44% of the exposed infants (n = 2,173) were born at term. First, results of unadjusted regression analyses using the entire sample showed the greatest reductions in BWT as compared to the other analytic methods: very preterm −61.26 g (±SE 24.12, P < 0.01), preterm −232.90 g (±SE 17.24, P < .001), near term −171.50 g (±SE 17.52, P < .001), and at term −101.95 g (±SE 10.89, P < .001). Second, using the entire sample, regression analyses adjusted for baseline and medical conditions showed significant differences in BWT between exposed and unexposed infants: very preterm −61.54 g (±SE 28.62, P < .03), preterm −222.78 g (±SE 19.64, P < .001), near term −159.25 g (±SE 19.14, P < .001), and at term −91.62 g (±SE 11.86, P < .03). Third, using the stringent PSM analyses based on matched subsamples, infants exposed to ACT weighed less at birth: −220.18 g (±SE 21.43, P < .001), −140.68 g (±SE 23.09, P < .001), and −89.38 g (±SE 14.16, P < .001), born preterm, near term, and at term, respectively. Similarly, significant reductions in BL and HC were also observed using the three analytic methods. There were no differences among postterm infants regardless of analytic method. Likewise, we observed no differences with respect to PI. Additional analyses showed that exposed and unexposed infants had generally similar Apgar scores at birth, yet the ACT-treated infants received greater medical care during the first 7 days of life and beyond. Our study is mainly limited by lack of data in FMBR specifying the interval between treatment and birth as well as other potential confounders that could not be tested. Conclusions In this study, ACT was consistently associated with reduction in birth size for infants born preterm, near term, or at term. Further investigation is warranted alongside reevaluation of guidelines. Efforts need to be made to correctly identify and target patients who will deliver preterm. Reduced growth should be considered when deliberating early care decisions.
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Pregnancies, ACT treatment, and timing of births.
2019Co-Authors: Alina Rodriguez, Mika Gissler, Yingbo Wang, Anohki Ali Khan, Rufus Cartwright, Marjoriitta JarvelinAbstract:ACT, Antenatal Corticosteroid therapy.
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exposure to Antenatal Corticosteroid therapy is associated with reduced size at birth evidence from finnish medical birth register of 278 508 births
Psychoneuroendocrinology, 2015Co-Authors: Mika Gissler, Alina Rodriguez, Yingbo Wang, Anohki Ali Khan, Rufus Cartwright, Marjoriitta JarvelinAbstract:Exposure to Antenatal Corticosteroid therapy is associated with reduced size at birth : Evidence from Finnish Medical Birth Register of 278,508 births
Terry Nolan - One of the best experts on this subject based on the ideXlab platform.
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Respiratory distress syndrome and Antenatal Corticosteroid treatment in premature twins.
Archives of Disease in Childhood-fetal and Neonatal Edition, 2001Co-Authors: D Hacking, A. Watkins, S Fraser, Rory Wolfe, Terry NolanAbstract:Editor—Randomised, placebo controlled trials of Antenatal Corticosteroid administration have not shown a significant reduction in the incidence of respiratory distress syndrome (RDS) in premature twins.1 Subsequent retrospective studies examining the effect of steroids on twin pregnancies have shown conflicting results.2 3 Further to our recent article,4 we have investigated the relation between respiratory distress and Antenatal Corticosteroid treatment in premature twins from the same historical cohort selected …
P Crowley - One of the best experts on this subject based on the ideXlab platform.
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Antenatal Corticosteroids—current thinking
BJOG: An International Journal of Obstetrics & Gynaecology, 2003Co-Authors: P CrowleyAbstract:Numerous investigations have indicated that Antenatal Corticosteroid administration reduces neonatal morbidity in preterm infants. Despite this, Antenatal Corticosteroid usage continued to be low on both sides of the Atlantic up to the late 1980s and early 1990s. Antenatal Corticosteroid therapy finally came of age in 1995 with the publication of the National Institutes of Health Consensus Statement on effects of Corticosteroids for fetal maturation on perinatal outcomes. The randomised trials of Antenatal Corticosteroid therapy have been based on the use of dexamethasone or betamethasone. However, observational evidence indicates differences in outcome, which may relate to the preparations themselves or to the preservatives included.
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Antenatal Corticosteroids--current thinking.
BJOG : an international journal of obstetrics and gynaecology, 2003Co-Authors: P CrowleyAbstract:Numerous investigations have indicated that Antenatal Corticosteroid administration reduces neonatal morbidity in preterm infants. Despite this, Antenatal Corticosteroid usage continued to be low on both sides of the Atlantic up to the late 1980s and early 1990s. Antenatal Corticosteroid therapy finally came of age in 1995 with the publication of the National Institutes of Health Consensus Statement on effects of Corticosteroids for fetal maturation on perinatal outcomes. The randomised trials of Antenatal Corticosteroid therapy have been based on the use of dexamethasone or betamethasone. However, observational evidence indicates differences in outcome, which may relate to the preparations themselves or to the preservatives included.
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Antenatal Corticosteroid therapy a meta analysis of the randomized trials 1972 to 1994
American Journal of Obstetrics and Gynecology, 1995Co-Authors: P CrowleyAbstract:Respiratory distress syndrome (RDS) and its complications are a key factor affecting mortality and immediate and long-term morbidity in preterm babies. In the course of investigating the initiation of parturition in sheep in 1969, Liggins’ observed that lambs born preterm after exposure to Corticosteroids in utero survived longer than control lambs. Subsequently, a randomized, placebo-controlled trial of betamethasone administration in women who were expected to give birth preterm found a statistically significant reduction in the frequency of respiratory distress in babies born before 32 weeks gestation and a fivefold reduction in neonatal mortality among preterm babies born after Corticosteroid administration, compared with administration of a placebo.* In the 22 years since this initial study, numerous investigations have suggested that Antenatal Corticosteroid administration reduces neonatal morbidity. However, obstetricians were slow to incorporate into clinical practice this ability to manipulate fetal lung maturity pharmacologically. A 1980 survey of self-reported practices among fellows and members of the Royal College of Obstetricians and Gynecologists resident in the United Kingdom showed that 42% used this treatment “frequently,” 40% used it “sometimes,” and 18% “never” used it.3 In a similar study of practices in northern Belgium and The Netherlands, Keirse4 found that only 32.5% of respondents used the treatment “routinely.” The recorded use of Antenatal Corticosteroids during the randomized controlled trials of surfactant therapy for neonatal RDS suggests that use of Corticosteroids continued to be low on both sides of the Atlantic until the late 1980s and early 1990s. Cortico-
Cheong-rae Roh - One of the best experts on this subject based on the ideXlab platform.
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short and long term neonatal outcomes according to differential exposure to Antenatal Corticosteroid therapy in preterm births prior to 24 weeks of gestation
PLOS ONE, 2018Co-Authors: Seon-mi Kim, Ji-hee Sung, Jin-yi Kuk, Hyun-hwa Cha, Suk-joo Choi, Cheong-rae RohAbstract:Aim To assess the effects of differential exposure to Antenatal Corticosteroid (ACS) on short- and long-term outcomes of infants born before 24 weeks of gestation. Methods This is a retrospective cohort study of 147 infants delivered by 116 women at 21–23 weeks of gestation between January 2001 and December 2016 at a tertiary referral hospital in Seoul, Korea. Eligible subjects were categorized into the following three groups according to ACS exposure: non-user (n = 53), partial-course (n = 44), and complete-course (n = 50). Univariable and multivariable analyses were used to compare neonatal mortality, neonatal morbidities including intraventricular hemorrhage (IVH), and neurodevelopmental impairment including cerebral palsy among the three groups. Results Neonatal mortality rate was significantly lower in the ACS-user groups (non-user, 52.8%; partial-course, 27.3%; complete-course, 28.0%; P = 0.01), but complete-course of ACS therapy had no advantages over partial-course. A lower incidence of IVH was observed in the complete-course group (non-users, 54.8%; partial-course, 48.6%; complete-course, 20.5%; P = 0.003). Multiple logistic regression analysis showed that ACS therapy, either partial- or complete-course, was associated with a lower rate of neonatal mortality (adjusted odds ratio (aOR) 0.375; 95% confidence interval (CI) 0.141–0.996 in partial-course; aOR 0.173; 95% CI 0.052–0.574) in complete-course). IVH (aOR 0.191; 95% CI 0.071–0.516) was less likely to occur in the complete-course group than in the non-user group. Neurodevelopmental impairment of survivors at 18–22 month after birth was not significantly different among the three groups. Conclusion ACS therapy in preterm births at 21–23 weeks of gestation was associated with significantly reduced rates of neonatal mortality and IVH, especially with complete administration.
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Neonatal outcome according to exposure to Antenatal Corticosteroid therapy.
2018Co-Authors: Seon-mi Kim, Ji-hee Sung, Jin-yi Kuk, Hyun-hwa Cha, Suk-joo Choi, Cheong-rae RohAbstract:Neonatal outcome according to exposure to Antenatal Corticosteroid therapy.
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Maternal characteristics and pregnancy outcomes according to exposure to Antenatal Corticosteroid therapy.
2018Co-Authors: Seon-mi Kim, Ji-hee Sung, Jin-yi Kuk, Hyun-hwa Cha, Suk-joo Choi, Cheong-rae RohAbstract:Maternal characteristics and pregnancy outcomes according to exposure to Antenatal Corticosteroid therapy.
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the effect of single or multiple courses of Antenatal Corticosteroid therapy on neonatal respiratory distress syndrome in singleton versus twin pregnancies
Australian & New Zealand Journal of Obstetrics & Gynaecology, 2009Co-Authors: Suk-joo Choi, Seung Eun Song, Eun Sung Seo, Jonghwa Kim, Cheong-rae RohAbstract:Background: Antenatal Corticosteroid (ACS) treatment is widely used for the prevention of respiratory distress syndrome (RDS) in preterm infants. However, the efficacy and safety of ACS treatment remains controversial in twin pregnancies. Aims: To investigate the effect of ACS therapy, single or multiple courses, on the incidence of neonatal RDS in singleton and twin pregnancies. Methods: We retrospectively evaluated the pregnancy and neonatal outcomes of 450 singleton and 117 twin pregnancies delivered at 24–34 weeks of gestation due to preterm labour or preterm premature rupture of membranes. The subjects were categorised into four groups according to ACS exposure: 0, 1, 2 and ≥ 3 courses. Results: Overall, RDS occurred more frequently in twins compared to singletons (41.0% vs 25.3%, P < 0.001). In singleton pregnancy, the incidence of RDS was significantly lower in the ACS user groups than in the non-user group, with the lowest incidence in the multiple course groups. An increase in the number of courses of ACS was associated with a reduction in the incidence of RDS (odds ratio 0.349, 95% confidence interval 0.226, 0.537, P < 0.001) independent of confounding variables. In twin pregnancies, however, the incidence of RDS was not significantly different in comparisons among the four groups. Conclusion: Multiple courses of ACS were associated with a significantly decreased risk of RDS in singleton pregnancies. However, the current standard dose or interval for ACS administration in singleton pregnancy, as either a single or multiple courses, did not reduce RDS in twins.